Chapter 47
Blood Specimen Collection
• Capillary Puncture
– Most common capillary puncture sites
for adults is the finger (fleshy pad of
middle or ring finger) on nondominant
hand, off center
– Earlobe is also common puncture site
for adults
Blood Specimen Collection
• Capillary Puncture
– Avoid using the thumb; it is often
callused.
– Avoid index finger if possible; has extra
nerve endings
– Avoid fifth finger; generally has less
tissue
Blood Specimen Collection
• Capillary Puncture
– Puncture should be a minimum of 2 mm
away from the fingernail
– Avoid any area showing signs of injury
or infection.
FIGURE 47-4 Capillary
puncture sites.
Blood Specimen Collection
• Capillary puncture on infants
– Puncture should occur on the medial
and lateral surfaces of the heel
– Patient can be held by his or her parent
or caretaker or another MA
– Baby's legs should hang to allow gravity
to increase blood flow
– Thoroughly clean and warm the heel
before the procedure.
Blood Specimen Collection
• Capillary puncture on infants
– Gentle friction or a warm (never
exceeding 42°C, 108°F), moist towel
can be applied for 3 to 5 minutes to
increase blood flow
– Never place an adhesive bandage on
patients younger than 2 years; could
create a choking hazard
FIGURE 47-6 Capillary
puncture equipment.
Blood Specimen Collection
• Equipment and Supplies
– Lancet
• Manual or automatic
• With automatic lancet the depth of the
puncture is controlled by a spring-loaded
mechanism, causing less pain to the patient
Blood Specimen Collection
• Equipment and Supplies
– Lancet
• Many are color-coded according to puncture
depth they can accomplish
• Place in a sharps container immediately
after use to prevent needlesticks
FIGURE 47-7 Springactivated lancet.
Blood Specimen Collection
• Equipment and Supplies
– Capillary tubes are designed to gently
pull the blood into the tiny opening.
– May have a blue mark (plain) or a red
mark (with heparin, to prevent clotting)
Blood Specimen Collection
• Equipment and Supplies
– Microtainer capillary blood collection
tubes have a variety of additives, noted
by the color-coded caps.
– Unopette collection devices can be used
for various blood cell counts.
Performing a Capillary
Puncture (Manual)
1.Perform hand hygiene.
2.Assemble equipment.
3.Identify the patient and explain the
procedure. Have the patient either
sitting or lying down.
4.Apply gloves.
Performing a Capillary
Puncture (Manual)
5.Select either the ring or great finger
on the nondominant hand for an
adult. Select a heel for a newborn.
Briskly rub the finger or heel
between your palms, to warm it up.
Wipe the site with alcohol. Let
alcohol evaporate.
6.Remove plastic protective tip to
expose the lancet.
Performing a Capillary
Puncture (Manual)
7.Grasp patient's hand (or infant's
heel) and gently squeeze 1 inch
below the chosen puncture site.
8.Puncture the site using a quick,
jabbing motion to obtain a full round
drop of blood. Do not puncture the
direct center. Immediately discard
the lancet in a sharps container. (A
spring-loaded lancet may also be
used.)
Performing a Capillary
Puncture (Manual)
9.Wipe away the first drop of blood
with a gauze square or cotton ball.
10.Obtain the sample using a
microhematocrit capillary tube. The
finger or foot may be gently
massaged or lowered below the level
of the heart, to increase blood flow.
Seal one end of the capillary tube in
a clay sealer.
Performing a Capillary
Puncture (Manual)
11.Apply clean gauze over the site and
ask patient to apply firm,
continuous pressure until the
bleeding stops.
12.Assess the patient and the site.
Apply a bandage, if needed, but
never on an infant (choking
hazard). Ask the patient if he or she
is dizzy or light-headed.
Performing a Capillary
Puncture (Manual)
13.Remove gloves and perform hand
hygiene.
14.Record the procedure on the
patient's medical record.
Performing a Capillary
Puncture (Manual)
Figure A Capillary
puncture procedure.
(continued) Performing a
Capillary Puncture (Manual)
Figure B Capillary
puncture procedure.
(continued) Performing a
Capillary Puncture (Manual)
Figure C Capillary
puncture procedure.
(continued) Performing a
Capillary Puncture (Manual)
Figure D Capillary
puncture procedure.
Blood Specimen Collection
• Venipuncture
– Safest and easiest sites to access are
located on the upper extremities
– Median cubital vein
• Located at the antecubital space, or the
inner elbow area
• Most popular
Blood Specimen Collection
• Venipuncture
– Cephalic and basilic veins
• Next most commonly used; large and
superficial
Blood Specimen Collection
• Venipuncture
– Sights to avoid
• Areas with hematomas, scars, or edema
– Avoid using an arm with a fistula,
vascular graft, or on the site of a
mastectomy
– If an arm with an IV must be used,
always choose a site below the IV
cannula and ensure that blood is not
being transfused in that extremity.
FIGURE 47-9 Anatomy of
an arm for venipuncture.
Blood Specimen Collection
• Phlebotomist
– MA who is trained to perform
phlebotomy; may perform venipuncture
in the medical office unless state
regulations state otherwise
– Practice of phlebotomy also takes place
in hospitals, blood banks, reference
laboratories, clinics, and other settings
Blood Specimen Collection
• Certification in Phlebotomy
– Often required at hospitals, blood
banks, and independent laboratories
– Benefits
•
•
•
•
Prestige
Increased job opportunities
Higher salary
Job security
Blood Specimen Collection
• Phlebotomy Technicians
– Collect and prepare blood and other
body fluid samples for medical
laboratory testing
– Can be a Certified Phlebotomy
Technician (CPT) or a Registered
Phlebotomy Technician (RPT)
Blood Specimen Collection
• Phlebotomy Technicians
– To become a phlebotomy technician, the
MA must meet standard qualifications
and must pass a written exam.
– Accrediting agencies: AMT, NCCT, and
NHA